Provider Demographics
NPI:1598413205
Name:MY GUARDIAN ANGEL PRS, LLC.
Entity Type:Organization
Organization Name:MY GUARDIAN ANGEL PRS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:R
Authorized Official - Last Name:D'AQUILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-624-0200
Mailing Address - Street 1:56 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:01370-1131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:56 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:SHELBURNE FALLS
Practice Address - State:MA
Practice Address - Zip Code:01370-1131
Practice Address - Country:US
Practice Address - Phone:413-624-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies